Why is my anxiety worse at night?

All day you’re busy and mostly fine. Then you switch off the light and it starts: replaying conversations, worrying about tomorrow, noticing your heartbeat. You’re exhausted, but your mind won’t stop.

If your anxiety gets worse at night, you’re not imagining it, and you’re far from alone. Here’s why it happens, and what helps.

Why anxiety gets worse at night

Fewer distractions

During the day, work, people and tasks keep your mind busy. At night, there’s nothing left to fill the space, so the worries you’ve been pushing aside all day finally get your full attention.

Tiredness lowers your coping

When you’re tired, the parts of your brain that keep emotions in check work less well. Problems seem bigger, and it’s harder to talk yourself down.

Your body is still and quiet

Lying still in a quiet room, you notice things you’d miss during the day: your heartbeat, a twitch, your breathing. If you’re prone to anxiety, those sensations can feel alarming.

Trying to sleep

Sleep can’t be forced. The harder you try, the more alert you become. After a few bad nights, bed itself can start to feel like a place of worry, and anxiety rises as bedtime approaches.

What you did earlier

• Caffeine can stay in your system for many hours, so an afternoon coffee can still be working at bedtime.
• Alcohol may help you drop off, but it disrupts sleep later in the night, and anxiety often rebounds in the early hours.
• Screens, news and social media before bed keep your mind switched on.
• A late, heavy meal can cause reflux or discomfort that keeps you awake.

Night-time panic attacks

Some people wake suddenly in a panic, with a racing heart and a feeling of dread. Night-time panic attacks are common, and they’re not a sign that anything dangerous is happening in your sleep. Our guide to anxiety and panic attacks explains what helps.

What helps

Move worrying to earlier in the day

Set aside 15 minutes in the early evening as “worry time”. Write down what’s on your mind and, for each worry, one small next step, or “nothing I can do tonight”. When worries show up in bed, remind yourself you’ve already dealt with them, and can come back to them tomorrow.

Build a wind-down routine

Give yourself 30 to 60 minutes to wind down before bed: dim the lights, put your phone away, and do something calm, like reading, a warm shower, gentle stretching or a sleep story. Doing the same things in the same order each night tells your body that sleep is coming.

Breathe slowly

Slow breathing, with a longer out-breath, helps your body switch into rest mode. 4-7-8 breathing (in for 4, hold for 7, out for 8) is popular at bedtime. Our post on calm, box and 4-7-8 breathing shows how.

Get up if you can’t sleep

If you’ve been lying awake for what feels like 20 minutes or more, get up and go to another room. Do something quiet and boring in dim light, and go back to bed when you feel sleepy. This helps your brain link bed with sleep, not with worrying. It’s a key part of CBT for insomnia.

Hide the clock

Checking the time and counting how many hours of sleep you have left adds pressure. Turn the clock away, and keep your phone out of reach.

Cut back on caffeine and alcohol

Try having your last caffeine around midday, and notice how alcohol affects your sleep and your mood the next day.

Be kind to yourself about sleep

One bad night is unpleasant, but you can cope with it. Reminding yourself of that takes the pressure off, which often makes sleep come more easily.

How Breatheasy can help

Breatheasy can help you wind down. Fall asleep to calming sleep sounds or a bedtime story read by Luma, or try 4-7-8 breathing with your phone pulsing gently as you breathe in. If you wake up in a panic, the panic button walks you through it. Breatheasy is coming soon to iPhone and Android.

When to get help

Talk to a doctor if anxiety at night is happening most nights, if you’ve been sleeping badly for three months or more, or if it’s affecting your days. The American College of Physicians recommends cognitive behavioural therapy for insomnia (CBT-I) as the first treatment for long-term sleep problems in adults. CBT can also treat the anxiety behind it.

If you’re feeling hopeless or having thoughts of ending your life, call or text 988 in the US, or call 911 if you’re in danger.

Sources

• Qaseem et al. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine.
• Insomnia, NHS
• Generalised anxiety disorder (GAD), NHS
• Panic disorder, NHS